Diabetes Care
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Diabetes Care 29:1331-1336, 2006
DOI: 10.2337/dc06-0255
© 2006 by the American Diabetes Association
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Purchase Article
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow Request Permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Azizi, M.
Right arrow Articles by Chatellier, G.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Azizi, M.
Right arrow Articles by Chatellier, G.
Social Bookmarking
Add to CiteULike   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?

Pathophysiology/Complications
Original Article

Assessment of Patients’ and Physicians’ Compliance to an ACE Inhibitor Treatment Based on Urinary N-Acetyl Ser-Asp-Lys-Pro Determination in the Noninsulin-Dependent Diabetes, Hypertension, Microalbuminuria, Proteinuria, Cardiovascular Events, and Ramipril (DIABHYCAR) Study

Michel Azizi, MD, PHD1,2,3, Joël Ménard, MD1,2,3, Séverine Peyrard, MSC1,2,3, Michel Lièvre, MD, PHD4, Michel Marre, MD, PHD5 and Gilles Chatellier, MD, MSC2,3,6

1 Institut National de la Santé et de la Recherche Médicale, CIC 9201, Paris, France
2 Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
3 Faculté de Médecine, Université Paris Descartes, Paris, France
4 Faculté de Médecine Laënnec, EA3736, Hôpitaux de Lyon, Lyon, France
5 Institut National de la Santé et de la Recherche Médicale, U695, and Assistance Publique Hôpitaux de Paris, Service d’Endocrinologie Diabétologie Nutrition, Groupe Hospitalier Bichat-Claude Bernard, Paris, France
6 Institut National de la Santé et de la Recherche Médicale, CIE 4, Paris, France

Address correspondence and reprint requests to Michel Azizi, MD, PhD, Centre d’Investigations Cliniques, Hôpital Européen Georges Pompidou, 20-40 rue Leblanc, 75908 Paris cedex 15, France. E-mail: michel.azizi{at}egp.aphp.fr

OBJECTIVE—The purpose of this study was to assess patients’ and physicians’ compliance with ACE inhibitor treatment, by measuring an endogenous biomarker of ACE inhibition, urinary N-acetyl-Ser-Asp-Lys-Pro (AcSDKP), in the Noninsulin-Dependent Diabetes, Hypertension, Microalbuminuria, Proteinuria, Cardiovascular Events, and Ramipril (DIABHYCAR) trial, which compared ramipril (1.25 mg o.d.) with placebo in 4,912 patients with type 2 diabetes and microalbuminuria/proteinuria.

RESEARCH DESIGN AND METHODS—The urine AcSDKP-to-creatinine ratio was measured blind to treatment in all participants who completed follow-up and provided spot urine samples (n = 1,871).

RESULTS—The median urinary AcSDKP-to-creatinine ratio was six times higher for ramipril than for placebo. Urinary AcSDKP-to-creatinine ratios displayed a bimodal distribution in both groups, with a very large intergroup overlap. Based on cluster analysis, we defined truly adherent ramipril patients as those with a ratio ≥4 nmol/mmol and truly adherent placebo patients as those with a ratio <4 nmol/mmol. After excluding patients withdrawing prematurely from the study or known to have used a nonstudy ACE inhibitor, 27.3% of the 597 ramipril patients had ratios <4, indicating poor compliance, and 9.7% of the 621 placebo patients had ratios ≥4, indicating intake of a nonstudy ACE inhibitor. Correcting for compliance by using AcSDKP-guided analysis affected surrogate outcome results (decrease in systolic blood pressure and urinary albumin excretion) only slightly.

CONCLUSIONS—The systematic use of spot urinary AcSDKP determination facilitated the detection of defects in compliance with ACE inhibitor treatment in both patients and physicians. Urinary AcSDKP measurement could be a useful biomarker for assessing compliance with ACE inhibition in the routine care of diabetic patients.

Abbreviations: AcSDKP, N-acetyl-Ser-Asp-Lys-Pro • DIABHYCAR, Noninsulin-Dependent Diabetes, Hypertension, Microalbuminuria, Proteinuria, Cardiovascular Events, and Ramipril • MICROHOPE, Microalbuminuria Cardiovascular Renal Outcomes-Heart Outcomes Prevention Evaluation • SBP, systolic blood pressure • UAE: urinary albumin excretion


Add to CiteULike CiteULike   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?




HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Diabetes Diabetes Care Clinical Diabetes Diabetes Spectrum
Copyright © 2006 by the American Diabetes Association.